Effect of hybrid assistive limb treatment on maximal walking speed and six-minute walking distance during stroke rehabilitation: a pilot study.
Hiroki Watanabe, Hideo Tsurushima, Hisako Yanagi
PMID 33642694WHAT IT FOUND
Adding HAL to usual physical, occupational, and speech therapy did not significantly improve change in maximal walking speed or six-minute walking distance versus conventional gait training plus usual therapy.
Both groups improved, but this small pilot cannot show HAL superiority.
Key findings
01The change in maximal walking speed and six-minute walking distance did not differ significantly between the HAL and conventional gait-training groups.
02Both groups improved several walking and function measures, but both also received usual physical, occupational, and speech therapy, so HAL alone cannot be credited.
03In a small balance subgroup, six-minute walking distance improved significantly more in the high-balance group than the low-balance group, while maximal walking speed did not improve significantly in either subgroup.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was a pilot with no calculated sample size, and only 20 patients were analyzed after withdrawals and missing walking tests. The HAL group was younger and had better baseline balance than the conventional group, which could affect the results. The same therapists delivered training and assessment, so observer bias cannot be excluded. Random assignment did not use allocation factors, contributing to baseline imbalance. Stride symmetry and detailed spatiotemporal gait parameters were not measured during walking. Both groups received usual physical, occupational, and speech therapy, so the effect of HAL alone cannot be separated from usual care.
Declared interests
The study was supported by the Ministry of Health, Labour and Welfare, Japan. The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that HAL improves walking speed or walking endurance more than conventional gait training. The between-group changes for maximal walking speed and six-minute walking distance were not significant, and both groups received usual physical, occupational, and speech therapy, so the contribution of HAL alone cannot be separated.